Vicky Lee and Carey Wooton tell BPM what three years of claims experience changed in plan design
GLP-1 drugs are in their third year as a live coverage decision on Canadian drug plans.
The International Foundation of Employee Benefit Plans (IFEBP) has surveyed Canadian employers on these drugs in each of the last three years, and coverage for both diabetes and weight loss has climbed from 17 percent in 2024 to 31 percent in 2025 and 37 percent in 2026, Carey Wooton, associate vice president of education at IFEBP, said in an email to Benefits and Pensions Monitor.
Diabetes-only coverage fell across the same three years, from 66 percent to 56 percent to 51 percent, per Wooton.
Twelve percent of 2026 respondents now cover the drugs for other conditions including sleep apnea and cardiovascular disease.
Health Canada approved the first generic semaglutide in April 2026, making Canada the first G7 country to authorize a generic version of the drug. Zepbound was authorized in June 2026 for moderate to severe obstructive sleep apnea in adults with obesity, the first approval of its kind in Canada.
The trajectory runs the other way in the United States, where the share of employers covering GLP-1 weight-loss drugs fell from 72 percent in 2025 to 60 percent in 2026, according to a previous report by Benefits and Pensions Monitor citing Reuters.
BPM Asks put five questions about claims experience, demand, retention, generic savings and coverage decisions to Wooton and to Vicky Lee, director of pharmacy consulting and professional services, payor solutions at TELUS Health. Both answered by email.
What claims experience has changed in plan design
“As obesity is becoming recognized as a chronic condition by many medical organizations globally, and treatment options like the GLP-1 drugs are more effective than their predecessors, more sponsors are adding coverage for anti-obesity medications that used to be a standard exclusion as a lifestyle drug on drug benefit plans,” Lee said.
“Our Canadian GLP-1 Drug Survey Reports from the last three years show that coverage of these drugs for weight loss has grown,” Wooton said, pointing to the steady decline in diabetes-only coverage since 2024 as the clearest marker of the shift.
How much member demand sponsors are actually seeing
“The clearest signal we have is prior authorization requests from a Pharmacy Benefit Manager.
Vicky Lee, TELUS Health
“The clearest signal we have is prior authorization requests from a Pharmacy Benefit Manager,” Lee said. Requests for Wegovy and Zepbound rose more than 50 per cent between 2025 and 2026 across the plans TELUS Health supports for prior authorization, she said, with paid claims for both drugs also rising.
Twenty-two percent of 2026 IFEBP respondents said patient and prescriber demand was a factor in their considerations on GLP-1 coverage for weight loss, according to Wooton. The survey did not report utilization rates or claim volumes.
What GLP-1 coverage does for recruitment and retention
“Employers rarely advertise coverage for specific drugs when posting for a role. Therefore, recruitment is more likely influenced by a generally robust drug plan than by any single therapy. Retention is where I would expect more of an effect. Employees who rely on a particular therapy have a reason to stay with a plan that covers it,” Lee said.
“Employees who rely on a particular therapy have a reason to stay with a plan that covers it.
Vicky Lee, TELUS Health
Wooton placed the benefit alongside fertility coverage. “While it may not be a benefit that every employee uses, it can be particularly valuable to certain segments of the workforce,” she said, adding that it helps “position the organization as responsive to evolving employee needs and expectations.”
“While it may not be a benefit that every employee uses, it can be particularly valuable to certain segments of the workforce.
Carey Wooton, International Foundation of Employee Benefit Plans
The talent case sits above the demand evidence either source produced. Fewer than a quarter of IFEBP respondents named demand as a coverage factor, and Lee’s retention argument applies to employees already on the therapy rather than to the wider workforce a competitive benefits package is designed to attract.
What generic semaglutide did to costs
“It is important to separate the treatment indications,” Lee said. “Generic semaglutide is available only for Ozempic, the diabetes product. For weight management-specific products such as Wegovy, generics are not available on the market.”
“Generic semaglutide is available only for Ozempic, the diabetes product. For weight management-specific products such as Wegovy, generics are not available on the market.
Vicky Lee, TELUS Health
Eligible spend on Ozempic and its generics fell about 40 per cent across the TELUS Health book even as claim volume rose, according to Lee. Net reduction across semaglutide overall is about 23 per cent, because Wegovy spend has risen without a market-available generic.
IFEBP did not address the cost effect of generic semaglutide. Its responses covered coverage rates, demand and plan design considerations only.
What to tell a sponsor still deciding
“It is a legitimate decision for plan sponsors to consider,” Lee said. Obesity is linked to comorbidities affecting health, productivity and absenteeism, she said, and treating it may carry downstream benefits for wellbeing and work. “But with the Wegovy generic still not yet market available and none for Zepbound, the cost exposure is a factor.” Her recommended guardrails are clear eligibility criteria set through prior authorization, and maximum spends.
Cost considerations include long-term medication use, eligibility requirements and whether coverage is restricted to specific conditions such as diabetes, obesity, cardiovascular disease or sleep apnea, Wooton said. “Employers must balance these costs against the potential for improved long-term health outcomes, reduced overall health care spending and the value of offering a benefit that may help attract and retain talent.”
For employers that decline weight-loss coverage, lifestyle modification, nutrition and wellness benefits are alternatives, per Wooton. “Adding to the complexity is the fact that GLP-1 medications are relatively new to the market for weight management,” she said. “Employers are still evaluating the long-term impacts to the health and overall well-being of their workers.”
